Influenza has not become prevalent in the community yet, but flu shot season is in full swing. The Centers for Disease Control and Prevention recommends routine annual influenza vaccinations for all those over the age of 6 months who do not have contraindications. Ideally, patients will be vaccinated by the end of October, or prior to the onset of flu activity within the community. The full CDC report, updated for the 2018 – 2019 flu season, can be found here.

E Central Medical Management (ECM), a New Hyde Park-based medical billing and management company, has been certified as a Minority Business Enterprise (MBE) by the New York State Division of Minority and Women’s Business Development.

Founded in 1999 by partners Louis Burke and Bert Lurch, the company has expanded beyond its original mission of providing outsourced medical billing services to independent practices. ECM is now a full-service medical consulting firm offering a suite of management services to primary care and specialty medical groups of all sizes. ECM clients may take advantage of the company’s expertise in credentialing, risk management, human resources, coding, out-of-network collections, marketing and an array ...

Healthcare may very well be the only industry in which the consumer does not pay directly for services. Instead, insurance companies and government payers are writing the checks, which makes them vitally important to the financial health of a practice.

Whether you are starting a new practice or you’ve been established for decades, navigating the credentialing process in order to be paid by a carrier requires attention, expertise and diligence. Here are a few tips for working with insurance panels:

• If you are starting a new practice, take everything.

“Don’t be choosy off the bat,” says Anthony J. Vuozzo, MPA, Practice Consultant at ECM. “Try to participate in as many panels as you can to get the money flo...

Are you running a medical practice, or running a business? If you are an independent physician, you’re doing both. You may find that wearing two hats – clinician and entrepreneur – is extremely demanding. But for many, the rewards are well worth the sacrifices.

The Clinician Hat

As a clinician, you received years of education and training. You spent time, effort and financial resources soaking up knowledge about anatomy and physiology, diagnostic techniques, pharmacology, therapeutics, the human body and more. And the learning never ends. You continue to update your skills and knowledge by reading journals and attending conferences and lectures. Taking care of patients is one of mankind’s highest callings. It is wha...

As a medical care provider, summer may bring a seasonal dip in your volume. You might use this time to sit back, relax, and enjoy the sunshine. But really savvy providers take advantage of the down time to review their office policies and procedures. An annual review can ensure that your office is running as efficiently as possible so that you can maximize your revenue once things get busy again.

Medicare is no longer accepting office consultations codes (99241-99245) or hospital consultations codes (99251-99255), as of January 1, 2010. Why? Well, the Office of Inspector General estimates that approximately 75% of consultations billed to Medicare were incorrect;specifically, 47% of consultation billing to Medicare involved wrong type or level of service, 19% did not meet definition of consult and 9% lacked appropriate documentation. Also, OIG audits have uncovered that in 2006 overpayments for consultations by the Medicare program amounted to approximately $1.1 billion in 2001.

Instead, “consultation” services will fall under the following codes, depending on the services rendered:Office Visits ( New patient or establ...

Some of my clients are charging extra fees on top of copays that are due. I keep telling them this may be insurance fraud, but they just don't listen. What do you think? I'm pretty sure this is a common practice and should be addressed.

Bert Lurch, President of E Central Medical Management(718) 525-4898

Answer:

The short answer is, you are correct Bert, that charging an extra administrative fee on top of a co-pay may be insurance fraud. For the extra charge to be legitimate, a Practice would have to have certain policies promulgated. Because a co-pay is determined by contract between a third-party payor and the patient, the amount is fixed and is to be collected as a fixed rate to represent the patient responsibility for those services rendered...

Q. I have a private practice and have privileges at a local hospital. Sometimes I schedule follow-up outpatient visits for my and the patient's convenience at the hospital, if they live closer to the hospital than my office. The space I use is in the ER, but the patients do not register with the ER. What place of service should I use for billing?

The below answer is provided by Louis Burke of E Central Management, a billing and management company that works with medical practices with code changes, patient billing and follow-up, and immediate appeals on underpaid or denied claims.

A. This is a tough one. The appropriate answer is that if you physically see a patient in the ER, even for outpatient services, you should be billing a code 23...